DEP/DUA/1/19/01 (Normalised version)

Isobel Porteus

(1778-1779)

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Isobel Porteus

From slightest view of case must appear that patient subjected to complication of affections.

And these too of very different durations

When came under our care most urgent part of complaint affection of breast.

And these might either be catarrhal or Phthisis.

For of both affections cough, soreness of throat, pain of side & difficulty of respiration are common & in some measure even constant symptoms.

When came under our treatment affection but of fourteen days standing.

And at this early period, difficult perhaps impossible to distinguish between catarrh & phthisis.

Or at least impossible to pronounce that catarrh which by that period nothing mitigated will not terminate in Phthisis

Yet can be no question that in many instances continues much longer where Phthisis does not occur.

Can only say that at time when case taken had no symptoms giving certainty of Phthisis.

Nor do I think that any such has yet occurred.

At same time with continuation of affection has been in no respect mitigated.

On contrary goes on with increasing violence.

And several symptoms which have since supervened give even stronger presumption of that affection.

Particularly night sweats, & Not improbable that diarrhoea which has now occurred of colliquative kind.

Must own therefore that very apprehensive patient subjected to this very dangerous affection.

And besides circumstances already mentioned suspicion corroborated by age, make of body, general appearance & other particulars.

Have not here indeed any appearance of purulent expectoration.

Nor is there reason to believe that is Phthisis of that kind arising from tubercles.

For there seldom at least that so much fixed pain.

And seldom that colliquative sweats to so great extent come on so soon.

From these circumstances, am inclined to suspect, that depends on vomica not yet [illegible].

This opinion however I deliver not as matter of certainty but as most probable conjecture.

And is a particular wish respect to which if have opportunity of seeing farther progress of disease may hereafter speak with more certainty.

At same time whether conjecture well founded or not can be little doubt that this part of affection of alarming nature.

But although most urgent not only complaint of patient.

And indeed long before any appearance of this subjected to other affections in nature very distressing.

These were great debility, affection of alimentary canal, swelling of stomach pain of back etc.

Was inclined however to consider all these as proceeding from one cause.

Discharge viz of white matter from Vagina.

Such a discharge is one of most characteristic symptoms in two different affections. Fluor Albus & Gonorrhoea

Between these diagnosis sometimes difficult.

But here could be no doubt from all circumstances of case taken together, that was of former kind.

And indeed sufficiently distinguished by flowing only during absence of Catamenia & following as consequence of these.

This circumstance alone, when does occur, & when can depend on veracity of patient, affords sufficient distinction.

And from debility induced by Leucorrhoea all circumstances with which at first affected very common consequences.

This then opinion of affection, when took this patient under our care.

Considered her as having been long subjected to Leucorrhoea on which Phthisis Pulmonalis had supervened.

With this idea could form no very favourable hopes as to termination.

And if opinion then unfavourable must be still more so at present.

First part of affection indeed when does prove fatal is only after very tedious & slow exhaustion of habit.

But recovery from Phthisis so rare that by many, when once distinctly marked considered as certainly fatal.

With our patient however progress of this part of affection seems every week to be more rapid.

And consider it a very unfavourable [appearance] that Catamenia have been for some time obstructed & that fluor albus has now left her.

In short shall be agreeably disappointed if this patient recovers.

But for my own part do not expect she will hold out for many weeks.

When such sentiments of disease need hardly say much respecting plan of cure

When takes place in Phthisis is chiefly to be expected from operation of system itself.

Different measures however by which urgent symptoms may be somewhat mitigated.

And even radical cure may be aided by means diminishing disposition to inflammation

And by means giving [illegible] from breast.

While on other hand after free discharge has once taken place may be forwarded by exciting adhesive inflammation giving ulcers [tendency] to heal.

Is I apprehend as tending to one or other of these ends that are to account for efficacy not only of climate, diet, & other articles of Regimen but also of medium as tending either to mitigation or removal of this affection.

And was with one or other of these views that different practices here ordered were intended.

First prescription was application of blister to side.

By this hoped that might mitigate [internal] inflammation with which then affected & then abate both pain & cough.

Previous to blister here might have had recourse to blood letting.

But to this constitution of patient & long continued Leucorrhoea afforded strong objections.

By this therefore in some measure [illegible] to blister as most efficacious measure which could employ

Was not however product of great advantage

For although obvious operation took place as could have wished, yet pain very little diminished & cough aggravated.

In this situation directed a refrigerant cathartic with view also to determination from breast.

And to this the rather led, as imagined that bound state of belly might aggravate other symptoms.

As such here ordered an electuary the basis of which was Cream of Tartar.

But in place of employing Cream Tartar alone conjoined with it two other articles a proportion viz of Lenitive electuary & of Spermaceti

From first of these additions had two intentions.

With many people, Cream of Tartar alone, from coldness excites uneasiness to stomach.

And in some instances occasions considerable gripes.

Both these effects, in some measure counteracted, by Lenitive electuary.

While at same time renders operation more certain.

Lenitive electuary indeed as prepared by Edinburgh College¹ is not now same medicine that was formerly.

And in opinion of greater part of [illegible] with whom I have conversed change which has been made rather for worse.

Formerly Senna in substance did not enter composition.

But this together with several other articles, formed into purgative syrup with large proportion of Sugar.

And in this state pulps added to it formed a mass by no means unpleasant.

By change which has now taken place Senna & Coriander seeds enter it in substance.

From these medicines unquestionably rendered more rough.

While as far at least, as my experience goes purgative quality not augmented.

And while other pulps thrown out that of prunes which of all others most apt to run into state of [fermented] [augmentation].

Perhaps in some measure from this reason but probably still more from want of former quantity of sugar, that now keeps worse than formerly.

And accordingly often met with in shops, in such a state, that can hardly suppose it to retain much of properties.

But although from these circumstances imagine that is less to be depended upon than formerly, yet where in sound state still look upon it to be a very useful & effective formula.

And as such directed it to present patient.

Was in hopes that might both [commence] influence of Cream of Tartar as exciting gripes & render operation as purgative more certain.

But besides this added also to Electuary another article viz Spermaceti.

Influence of this, as far as has any [effect] on discharge by belly, rather to render it easy as otherwise.

But here principle intention which had in view, from use, was that might operate as demulcent.

And this effect, am inclined to think, may exert, after entering system, at mucus excretion.

Some indeed who contend to demulcent no other influence than as lubricating fauces.

But for my own part can see no great difficulty in these entering circulation, than different stimulants acting on most remote parts of system, as organs for secretion of urine, saliva or like.

And cannot help thinking that evidence for one little less strong than for other.

Hold therefore that by this medicine as taken into stomach irritation at lungs may be diminished.

And imagine that the accomplishing this end might be of advantage in present case.

How far in any degree had influence in this way, can not, pretend to say.

But in operation as purgative a good deal disappointed.

For to extent to which first ordered to be taken at least had little affect.

And as demulcent did not think of [trusting] alone to Spermaceti introduced into Electuary.

For with same intention, but still more especially with view of lubricating fauces directed patient use of mucilage mixture or julep, of which basis Gum Arabic.

If conjecture as to cause of cough well founded could not expect that from this medicine would be removed.

Yet hoped that might at least have some share as diminishing irritation by which sometimes excited.

And whether from this, from electuary or from any other cause was at least for some time considerably mitigated.

But from being disappointed in purgative effect of electuary augmented dose.

And with view to mitigation of pain of side ordered repetition of blister.

Neither one nor other however [attended] with desired effect.

As mitigation of pain, an end which did not expect to accomplish did nothing [father] with that view.

And hoped that by still increasing dose of electuary might at length move belly to sufficient degree.

While by continuation of mucilage mixture although did not look for removal, yet expected some mitigation of cough.

While in this state menses formerly regular did not appear at usual period.

This in many instances of Phthisis not the case even when patient highly [extr].

But when amenorrhea does happen at late periods always to be looked upon as consequence of disease

And I think to be ranked among worst symptoms.

For imagine that best to be explained from failure of circulation in extreme vessels.

And happens on same principle as [red] [vessels] entirely [disappeared] on [illegible] [illegible] of eyes.

Although therefore with this mitigation of Leucorrhoea consider it as indicating more dangerous state.

And must own that since, have had very faint hopes, not merely of recovery but even of any considerable mitigation of symptoms.

As electuary however, after utmost dose to which increased, still ineffective was led to alteration of it.

And in place of Lenitive of Electuary [endeavour] to mitigate effects of Cream of Tartar by Flores Sulphuris

While at same time by addition of Jalap was objective to render operation more secure.

From this at first desired effect.

And on repetition even more effect than could have wished for.

In consequence of use had frequent loose stools.

From this however even more to be dreaded than from constipation.

As in exhausted state of patient [unfit] for any evacuation.

Especially while so much [wasted] by profuse colliquative sweats.

This therefore led me to intermit employment.

With intention however as have since done of having again recourse to it when occurrences might require.

With this palliative continued also with nearly same intention both use of mucilage mixture, & drain from side.

From latter had some hopes that benefit might both arise by derivation from lungs, & that outlet might be afforded to absorbed pus.

For hold that by every issue new secretion as it were formed from system.

And that will afford more ready outlet to some matters than others.

In this manner is often I think useful even in very late stages of Phthisis.

Yet where disease far advanced so little prospect of benefit that hardly to be urged upon patients contrary to inclination.

And on this account here gave up [continuation].

Or at least after being allowed to cease did not urge renewal.

In present situation of patient do not imagine that any measures advisable with view to radical cure.

And of natural, must own have very little expectation.

As this however still a possible event shall at least go on with gentle [illegible] measures.

And as such can employ nothing either more innocent or that has greater prospect of easing patient than Mucilage mixture.

At same time directing repetition of laxative electuary when occasion requires.

Do not however imagine that shall even have long occasion to continue this course

For suspect that Death will soon terminate complaint.

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Explanatory notes:

1) The Royal College of Physicians of Edinburgh, established in 1681.